Transcript Inequalities in health 2: Ethnicity

INEQUALITIES IN HEALTH
2: ETHNICITY
G672
Recap: Whiteboards

What do we mean by ‘ethnicity’?

How does this differ from race and nationality?
Race, Ethnicity & Nationality
Concept
Meaning
Race
Biological differences, linked to
phenotypes (physical characteristics)
and genotypes (underlying genetic
differences).
Ethnicity
Groups within society that share things
like culture, traditions, language,
religion, race, ancestry etc.
Nationality
A sense of ‘belonging’ to a particular
nation through origin, birth or
naturalisation.
Q: Which Sociologist described the different features of ethnicity?
Culture
Clothes,
religious
values,
food,
tradition
Ethnicity
(Modood;
2005)
Language
Descent &
Geographical
Origin
Sense of
Identity
Definitions Check: Whiteboards
(define min. 3)
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MULTICULTURALISM
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SUPERDIVERSITY
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CULTURAL DIVERSITY
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HYBRIDITY
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ETHNIC MINORITY
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CODE SWITCHING
Race or Ethnicity?
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Race is often regarded as an outdated concept and
sociologists prefer the broader concept of ethnicity...
However, some argue that race is a better term for
explaining the position of ethnicities at the bottom of
the social stratification system – because sociologists
like Miles (1989) have identified racism as the main
cause...
Whiteboards: Which are the main ethnic groups in
Britain?
Ethnic Groups: England & Wales
Q: Which groups are not represented above?
Q: Why does this differ from the usual ‘official’ figure of 9% ethnic minority groups in
the UK?
Difficulties in studying
Ethnicity/Health
In Pairs:
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What extraneous factors might complicate these
studies? Identify at least three factors.
Look at Modood’s definition of ethnicity: Why
might it be difficult to use the concept of
‘ethnicity’ in studying health?
Difficulties in studying
Ethnicity/Health
Extraneous Factors:

Does ethnicity matter more than income, occupation,
gender, age, class, birthplace etc. in measuring
health?
Difficulties in studying
Ethnicity/Health
Operationalising Ethnicity:
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Researchers wanting to measure ethnicity will need
to operationalise (make measurable) the concept.
Different researchers may operationalise the
concept differently, making results and studies
difficult to compare.
Difficulties in studying
Ethnicity/Health
Extraneous Factors: What does this table show –
and what does it suggest about difficulties in
studying ethnicity/health?
Group
Under 15
(%)
16-44 (%)
45-64 (%)
65-74 (%)
75+ (%)
White
19
42
22
9
7
Black,
Caribbean
22
48
25
4
1
Black, African
29
59
10
1
0
Pakistani
43
43
12
1
0
Bangladeshi
47
38
14
1
0
Chinese
23
59
12
2
1
Ethnic differences in Health
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Most minority groups have higher mortality rates.
Most ethnic groups have higher rates of still-birth
and infant mortality
Africans and Afro-Caribbeans are 50% more likely
to die of stroke
Asians 50% more likely to die of heart disease
Most ethnic groups have lower rates of cancer
Afro Caribbeans are 7 times more likely to be
diagnosed as psychotic
Age-standardised “not good” health
rates (2001) – based on self-reporting.
In Pairs
Consider the different types of explanation. For each,
decide on at least two explanations as to why some
ethnic minorities experience lower life expectancy and
higher rates of illness:
ARTEFACT
BIOLOGICAL
CULTURAL/BEHAVIOURAL
STRUCTURAL/MATERIAL
MIGRATION/RACISM
Genetic/Biological Factors
Genetic/Biological Factors

Some disorders have clear genetic causes e.g. Tay
Sachs disease among the Jewish population; sicklecell anaemia among Afro-Caribbeans.
http://www.nhs.uk/conditions/tay-sachsdisease/Pages/Introduction.aspx
http://www.nhs.uk/conditions/Sickle-cellanaemia/Pages/Introduction.aspx
Genetic/Biological Factors
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However, this explanation only works for a few such
disorders.
Zubin & Spring (1977) pointed out that some
people are genetically vulnerable to schizophrenia
but it is mainly down to lifestyle that decides if or
how symptoms ever appear.
Individual/Behavioural Factors
Individual Behaviour
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As individuals, we make choices about how to
behave...
...Therefore, it is up to us whether we make the right
or wrong decisions regarding our health.
“The real cause of poor
health among Northerners is
their choice of diet. People
should look after themselves
better.” – Edwina Currie,
1986
Individual Behaviour (Things YOU
do/avoid): Copy & Complete
Activity
High or low
risk to health?
Why a risk?
Short-term or
Why do you
long-term risk? do/avoid the
activity?
Individual Behaviour: Table
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Are your choices/decisions similar to those of
others?
How closely are your choices/decisions linked to
your ideas about health risks (e.g. Do you always
avoid things with long-term risks?)
Identify at least five healthy activities.
Individual Behaviour
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There is some argument that certain ethnic groups are
more likely to make healthy lifestyle choices than others
(e.g. Choice of diet).
http://www.youtube.com/watch?v=x3D3geTEIco
However, this view is debatable: Many of these ‘choices’
might be more closely linked to cultural beliefs (e.g.
Particular foods might be eaten/avoided for religious
reasons, not as a lifestyle choice).
What does the graph suggest about individual behaviour and
ethnicity? What problems might there be with this data?
Cultural Factors
Cultural Explanations
To what extent does the way of life of different
ethnic groups affect their chances of getting ill?
In terms of smoking rates, you cannot make
generalisations about ethnicity.
It is vital to take into account social class, regional
or religious variations.
Cultural Explanations
To what extent does the way of life of different
ethnic groups affect their chances of getting ill?
‘Asians’ (statistically) experience high levels of heart
disease. This has been linked to their use of fats like
ghee in cooking...
...But many ‘Asians’ (e.g. Those from South India)
traditionally eat very healthy, vegetarian diets...
...So statistics that describe ‘Asians’ as a single group are
flawed – as are such assumptions about ethnic groups.
Cultural Explanations
To what extent does the way of life of different
ethnic groups affect their chances of getting ill?
Many cultural factors actually favour the health of
ethnic minorities.
For example, as we’ve seen, Bangladeshi women
have the lowest smoking rates of any group.
Mortality rates from lung cancer and chronic
bronchitis are extremely low in people from the
Indian sub-continent.
Cultural Explanations
Complete the evaluation of cultural explanations by
filling in the missing words on your worksheets.
Beneath this, in a couple of sentences, summarise
the meaning in your own words.
Material/Structural Factors
Material/Structural Explanations
Key Question:
To what extent do people’s material
surroundings/living conditions and position in the social
structure explain their ill-health?
Are some ethnic groups materially better off than
others?
Labour Force Survey (1998-2000)
41% of white men in the highest two social class
groups, compared to:
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47% of
44% of
33% of
31% of
23% of
Indian men
Chinese men
black men
Pakistani men
Bagladeshi men and…
Labour Force Survey (1998-2000)
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41% of
34% of
34% of
33% of
29% of
Chinese women
white women
black women
Indian women
Pakistani/Bangladeshi women
Material/Structural Explanation #1:
Unemployment
Unemployment: Place in order of likelihood of being jobless:
Material/Structural Explanation #2:
Type of Work
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Amin (1992) claimed that some ethnic minorities
are concentrated in more hazardous work –
therefore suffer more accidents/work related
illnesses.
Material/Structural Explanation #3:
Housing & Homelessness
1.
2.
3.
A survey of homeless households (placed in B&B
accommodation) found that:
The majority were of ethnic minority
background
The majority of the adults were between 16-34
Only 56% spoke English as a first language
Material/Structural Explanation #3:
Housing & Homelessness
Lissauer et al (1994) examined complaints made
by this group, many of which have potential risks to
health and wellbeing:
Nature of complaint
How many complained
Lack of space
70%
Nowhere for children to play
68%
Isolation
58%
Noise
38%
Lack of privacy
32%
Material/Structural Explanation #3:
Housing & Homelessness
People in this situation experience:
 Having to relocate regularly...
 ...Therefore difficulty registering with a GP
 Increased likelihood of using hospital emergency
services
 Higher rates of depression
 Higher rates of mild childhood illnesses
Evaluation: Whiteboards
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For the following statements, you need to decide
which is a strength and which is a weakness of
material/structural explanations.
Write S or W on your whiteboards...
Strength or Weakness?
The material explanation is supporting by a variety
of evidence that shows ethnic groups suffer
higher rates of unemployment and deprivation.
Strength or Weakness?
The material explanation often treats ethnic
minorities as one homogenous group rather than
exploring differences between them
Strength or Weakness?
The material explanation does not consider the
relationship between lifestyle and material
circumstances
Strength or Weakness?
The material explanation doesn’t consider the
relationship between gender, age and region
with material circumstances
Strength or Weakness?
The material explanation does not ‘blame’ victims
for their illnesses
Strength or Weakness?
Material factors are useful in explaining some
illnesses (e.g. Depression) but not all illnesses
Migration & Racism
Migration & Racism
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Brown (1994) states that racial discrimination and
harassment may have an adverse effect on health
(e.g. for stress, personal injury).
Asians are 50 x more likely than white people to
suffer racial victimisation...
Black people are 36 x more likely...
Artefact Explanations
Artefact Explanations
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‘Evidence’ linking ethnicity to illness and death can
be misleading.
Material/structural factors like unemployment are
probably more significant overall...
...Plus there are many additional variables to be
taken into account e.g. Gender, age, region...
Homework
Outline and evaluate the view that
genetic/biological factors cause some ethnic
minorities to experience more ill health than
others [33]
Due: Next Lesson
Ethnicity & Mental Illness
Ethnicity & Mental Illness
Nazroo (1997)
 African-Caribbean people are more likely to suffer
depression but less likely to suffer anxiety. They
are also over-represented in treatment for
psychotic disorders.
 People of South Asian origin have the lowest rates
of depression.
Ethnicity & Mental Illness
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Black adolescents (especially those born outside of
the UK)are over-represented in mental health
services (Tolmac & Holmes; 2005).
People of African-Caribbean origin are most likely
to be referred to mental health services via the
police, courts or prisons (Rogers & Pilgrim; 2005).
Explanations
If you get a question on ethnicity and mental health
in the exam, you should use the same CULTURAL
AND MATERIAL EXPLANATIONS as those that
explain general ethnic health inequalities.